경정맥공 종양의 수술적 접근법

Abstract

Background: The infratemporal fossa approach type A (ITFA-A) is a good approach for small jugular foramen tumors with a small extraforaminal cervical extension. On the other hand, the posterolateral approach to jugular foramen has been adopted to see the posterior aspect of the jugular foramen. For large tumors, we combined posterolateral approach with various otologic operations including ITFA-A, transcochlear approach and fallopian bridge technique. The purpose of this study is to evaluate the surgical adequacy of our approaches including postoperative complications and outcomes. Methods: From January 2014 to January 2017, we operated total 14 cases of jugular foramen tumors. We chose the surgical approach to these tumors based on their location and extent. And the facial nerve manipulation was added in combined approach in which facial nerve was dissected and transpositioned (3 cases) or remained in fallopian canal (fallopian bridge technique, 3 cases). Results: Grossly total resection was achieved in 12 patients (85.7%). Immediate postoperative lower cranial nerve deficit occurred in 10 patients (71.4%). Postoperative facial nerve paralysis and hearing impairment occurred in 4 patients (28.6%) and 6 patients (42.9%) respectively. Two-thirds of the jugular foramen could be exposed in the combined approach which enabled the complete removal of tumors regardless of the size at this area. Conclusion: Using skull base technique with thorough understanding of surrounding anatomic structures followed in wider exposure, gross total removal can be achieved by multidirectional approach under relative safety.